What does the new National Medical Commission Bill entail? A primer

Though the introduction of the National Medical Commission (NMC) has received an enthusiastic response from some elements, the medical fraternity has not been enthusiastic about the new changes which the new rules are about to bring.

The new body, the National Medical Commission would comprise of multiple committees and departments and would be open to practising doctors. The body would bring about significant changes and has proposed newer steps such as exit exams for MBBS students, a regulatory structure for fees in medical colleges, especially private medical colleges and a nationwide registry for medical practitioners.

What does the new National Medical Commission Bill entail? 
The Union Cabinet recently approved the National Medical Commission Bill in December 2017. The Bill is a major overhaul of the current Indian Medical Council Act of 1956. The new Act has potentially far-reaching implications for everyone in the medical fraternity, including medical students, medical aspirants, doctors and medical administrators.
We give you a low down on some features and provisions of the new Act for various stakeholders.
Medical students and colleges
A new, common national licensing exam is likely to be started soon, most probably within three years, which will be required for all MBBS students on the cusp of graduation. This test will be taken to judge the quality of their medical training, and it will simultaneously serve as a qualifying exam for postgraduate admissions as well as the eligibility requirement for providing their license before they can practice medicine. However, what will be the fate of those failing in this exam will be decided only after more details of the examination and its nature emerges.
A controversial and potentially problematic move is the regulation of fees for only 40% of the seats in private medical colleges. This could be a major misstep in terms of keeping medical education affordable since the colleges will be free to set the desired amount for the remaining 60% seats. This could lead to exorbitant rates being charged by these colleges from students not eligible for merit seats.
Finally, in an attempt to rationalize qualifications and eligibility for practice, the qualification of Diplomate in National Board (DNB) will now be equivalent to the MD/MS degree and will be allowed to practice and teach in medical colleges.
Earlier, medical colleges required the MCI’s approval for establishment, recognition, renewal of the yearly permission or recognition of degrees, and even increase the number of students they admitted. The new bill seeks to reduce the red tape, and annual
Medical practitioners
The Act provides for the formation of a National Register of doctors, as part of a two-tiered structure wherein another register will be formed at the state level. The register will be maintained in a digital form which will be periodically updated and contain the names of all medical practitioners in the country. Only those clearing the national licensing exam will be considered eligible for entry into the registry.

Key features of the National Medical Commission
The National Medical Council is set to have a much more layered structure, which will have a markedly different governing structure to its predecessor, the MCI (Medical Council of India). This includes changes in the manner in which requisite policies for the governance of medical education will be framed and monitored for keeping the quality of medical education intact.
Some of the key features of the NMC regarding educational governance are:
To avoid the concentration of power like in the case of the MCI, four mutually independent and autonomous Boards will be established under the supervision of the NMC. The names and responsibilities of the four sub-boards are:
1. Under Graduate Medical Education Board (UGMEB): This section will monitor medical education at the Undergraduate level including setting guidelines and standards for establishing medical institutions, development and decisions regarding course contents, monitoring the quality and regulation of examinations and faculty, and developing a competency-based curriculum and facilitating the spread of research among this pool of medical students.
2. Post-Graduate Medical Education Board (PGMEB): This sub-board will be responsible for all of the above mentioned activities as handled by the UGMEB, but only at the Post Graduate level. Another significant step is that the National Board of Examinations (NBE) may be merged with the PGMEB, which might eventually be dissolved after handing over all its tasks to the PGMEB.
3. Medical Assessment and Rating Board (MARB): The MARB will be responsible for monitoring the formation, establishment and maintaining the quality of medical institutions. The Board will also grant permissions for establishment of new institutions after the UGMEB/PGMEB standards are met. Along with the monitoring tasks, the MARB will also rate and assess hospitals, monitor disparities and shortcomings and levy fines and penalties and ensure that the NMC norms are followed.
4. Board for Medical Registration (BMR): This board will be tasked with the maintenance of the national register and monitoring the ethical practice of medicine by practitioners. The State Medical Councils will be under the BMR’s appellate jurisdiction and the BMR will have the jurisdiction over all state Councils, hence tasking them with much more than simply maintaining the register and basic compliance.
Finally, another slightly controversial proposition is that medical colleges will only need to apply for establishment and recognition but the need for annual renewal as was the process under the MCI. However, more details need to be provided regarding monitoring of quality. In terms of levying fines and maintaining quality, medical colleges flouting norms will be heavily fined, proposed at up to ten times the tuition fees charged by them, however, the provision of cancelling the license of a college has been removed, which may prove to be controversial. While the MCI was accused of arbitrarily cancelling licenses, doing away with it altogether is a major step.
The size of the Commission is likely to be 25, including one Chairperson, One Member Secretary, 12 ex-officio members and 11 part-time members. At least five part-time members will be appointed from outside the medical profession from fields they can be from fields such as management, law, economics and science and technology.
Two independent bodies will function parallel to the NMC – a five-member Search and Selection Committee (SSC) which will fill vacancies in the NMC; and a 64 member Medical Advisory Council (MAC) comprising all the NMC members and representatives of each state and Union Territory which will guide the actions of the NMC. Most of these members will be nominated by the Central Government and not elected as used to happen for the MCI.
This is probably, one of the most controversial moves since the IMA has noted that this may lead to filling up of the positions of authority by people who are closer to the ruling dispensation. On the other hand, the MCI had been accused of becoming a ‘club’.
Overall, the NMC Bill seeks to bring large changes in the sector, however, some of its provisions need to be made watertight and means to address malpractices need to be set in place.

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